The American College of Radiology (ACR) has updated its MR safe practice guidelines. The 2007 version represents a virtual rewrite of the entire document and contains information on, among other topics, nephrogenic systemic fibrosis (NSF), a reaction to gadolinium that has been noted in patients with renal disease.

There are potential risks in the MR environment, not only for the patient [1, 2] but also for the accompanying family members, attending health care professionals, and others who find themselves only occasionally or rarely in the magnetic fields of MR scanners, such as security or housekeeping personnel, firefighters, police, etc. [3–6].

There have been reports in the medical literature and print media detailing magnetic resonance imaging (MRI) adverse incidents involving patients, equipment, and personnel that spotlighted the need for a safety review by an expert panel.

To this end, the American College of Radiology (ACR) originally formed the Blue Ribbon Panel on MR Safety. First constituted in 2001, the panel was charged with reviewing existing MR safe practices and guidelines [5–9] and issuing new ones as appropriate for MR examinations.

Published initially in 2002 [3], the ACR MR Safe Practice Guidelines established de facto industry standards for safe and responsible practices in clinical and research MR environments. These were subsequently reviewed and updated in May 2004 [4].

After reviewing substantial feedback from the field and installed bases, as well as changes that had transpired throughout the MR industry since the publication of the 2004 version of this document, the panel extensively reviewed, modified, and updated the entire document in 2006–2007.

The present panel consists of the following members: A. James Barkovich, MD; Charlotte Bell, MD (American Society of Anesthesiologists); James P. Borgstede, MD, FACR; William G. Bradley, MD, PhD, FACR; Jerry W. Froelich, MD; Tobias Gilk, architect; J. Rod Gimbel, MD, FACC, cardiologist; John Gosbee, MD, MS; Ellisa Kuhni-Kaminski, RT (R)(MR); Emanuel Kanal, MD, FACR, FISMRM (chair); James W. Lester, MD; John Nyenhuis, PhD; Yoav Parag, MD; Daniel Joe Schaefer, PhD, engineer; Elizabeth A. Sebek- Scoumis, RN, BSN, CRN; Jeffrey Weinreb, MD; Loren A. Zaremba, PhD, FDA; Pamela Wilcox, RN, MBA (ACR staff); Leonard Lucey, JD, LLM (ACR staff); and Nancy Sass, RT (R)(MR)(CT) (ACR staff).

The following represents the most recently modified and updated version of the combined prior two reports [3, 4] issued by the American College of Radiology Blue Ribbon Panel on MR Safety, chaired by Emanuel Kanal, MD, FACR. It is important to note that nothing that appears herein is the result of a 'majority vote' of the members of this panel.

As with each prior publication of these ACR MR Safe Practice Guidelines, the entire document, from introduction to the markedly expanded appendices, represents the unanimous consensus of each and every member of this Safety Committee and the various areas of expertise that they represent. This includes representation from fields and backgrounds as diverse as MR physicists, research/ academic radiologists, private practice radiologists, MR safety experts, patient safety experts/researchers, MR technologists, MR nursing, National Electrical Manufacturers Association, the U.S. Food and Drug Administration (FDA), the American Society of Anesthesiologists, legal counsel, and others.

Lay personnel, physicians, PhDs, department chairs and house-staff/residents, government employees and private practitioners, doctors, nurses, technologists, radiologists, anesthesiologists, cardiologists, attorneys—these are all represented on this Committee.

It was felt that achieving unanimity for these guidelines was critical in order to demonstrate to all that these guidelines are not only appropriate from a scientific point of view, but are reasonably applicable in the real world in which we all must live, with all its patient care, financial, and throughput pressures and considerations.

The following MR safe practice guidelines document is intended to be used as a template for MR facilities to follow in the development of an MR safety program. These guidelines were developed to help guide MR practitioners regarding these issues and to provide a basis for them to develop and implement their own MR policies and practices.

It is intended that these MR safe practice guidelines (and the policies and procedures to which they give rise) be reviewed and updated on a regular basis as the field of MR safety continues to evolve.

The principles behind these MR safe practice guidelines are specifically intended to apply not only to diagnostic settings but also to patient, research subject, and health care personnel safety for all MRI settings, including those designed for clinical diagnostic imaging, research, interventional, and intraoperative MR applications.

With the increasing advent and use of 3.0-Tesla and higher strength magnets, users need to recognize that one should never assume MR compatibility or safety information about a device if it is not clearly documented in writing. Decisions based on published MR safety and compatibility claims should recognize that all such claims apply only to specifically tested conditions, such as static magnetic field strengths, static gradient magnetic field strengths and spatial distributions, and the strengths and rates of change of gradient and radiofrequency (RF) magnetic fields.

Finally, there are many issues that impact MR safety that should be considered during site planning for a given MR installation. These have historically not been dealt with in the prior versions of the ACR MR Safe Practice Guidelines.

For the first time, we include in this article, as separate appendices, sections that address such issues as well, including cryogen emergency vent locations and pathways, 5-gauss lines, siting considerations, patient access pathways, etc. Yet despite their appearance herein, these issues, and many others, should be reviewed with those experienced in MR site planning and familiar with the patient safety and patient flow considerations prior to committing to construction of a specific site design. In this regard, enlisting the assistance of an architectural firm experienced in this area, and doing so early in the design stages of the planning process, may prove most valuable.

It remains the intent of the ACR that these MR Safe Practice Guidelines will prove helpful as the field of MRI continues to evolve and mature, providing MR services that are among the most powerful, yet safest, of all diagnostic procedures to be developed in the history of modern medicine. Kanal E, Barkovich AJ, Bell C, et al. for the ACR Blue Ribbon Panel on MR Safety Reproduced with the permission of the American College of Radiology.

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